Reintegrating abortion care and cultivating the next generation of providers

Many in the reproductive rights movement are acutely aware of the divide that exists between abortion providers and mainstream medicine. While the government recognizes a woman’s right to a safe and legal abortion, our policies and medical realities don’t show it very well. Not only does the country place a huge barrier to low-income access through the Hyde Amendment, which bans the use of public funds for abortions, we also isolate abortion providers, forcing women to seek out stand-alone clinics in order to receive the care they need.

Following the passing of Roe vs Wade, which affirmed a woman’s right to choose, it was predicted that if only half the country’s obstetricians provided abortion care services, clinics would be unnecessary.

After Roe, the shadow of the greedy, butchering “abortionist” continued to hover, and many doctors didn’t want to stand in it. As mainstream medicine backed away, feminist activists stepped in.

Initially a huge success for women’s rights, these stand-alone clinics soon became poised to further the divide between abortion providers and hospitals. In an attempt to secure abortion providers within mainstream medicine, they had now provided conservatives an opportunity to ultimately remove abortion care from the public’s view.

Major repercussions included: clinics being targeted by extremists, their reinforcement of “outsider status” by the medical profession, and consequently, the removal of abortion training from residency programs. However, there exists a silver lining for the future of abortion rights and its reintegration in mainstream medicine:

This abortion-rights campaign, led by physicians themselves, is trying to recast doctors, changing them from a weak link of abortion to a strong one. Its leaders have built residency programs and fellowships at university hospitals, with the hope that, eventually, more and more doctors will use their training to bring abortion into their practices. The bold idea at the heart of this effort is to integrate abortion so that it’s a seamless part of health care for women — embraced rather than shunned.

While there is a long way to go before abortion care becomes securely established within general medicine (like it was supposed to be), the amount of new fellowship and residency programs springing up around the country is definitely promising. These programs are effectively targeting the best doctors and those who want to join medical-school faculties. In spite of efforts to curtail its expansion, the surprising truth is that however controversial abortion remains in America; its support from academic medicine is secure.

What is the future for new abortion providers? While fellowships and residency programs are able to provide “training to competency,” which certifies a doctor to perform an abortion unsupervised, we have yet to see this translate into better access for women.

This highlights the challenge of making abortion truly mainstream — of moving beyond residency training and outside the haven of medical-school faculties, so that more doctors offer abortions when they join a regular OB-GYN or primary-care practice. As yet, all the success in training new doctors hasn’t translated into an increase in access.

In the face of such logistical realities, I feel it is still reassuring to say that the societal environment is changing, and it will simply take more time and advocacy work in order to increase training and access to abortion. Maybe someday (within this decade?) a woman will be able to see her family doctor and the nature of her visit will remain unknown to the rest of the patients in the waiting room. She won’t need to enter an abortion clinic, facing a wave of anti-choice protesters. It will be just like any other day at the doctor’s office.